Provider First Line Business Practice Location Address: 
234 CORAOPOLIS RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CORAOPOLIS
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15108-4004
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-331-6060
    Provider Business Practice Location Address Fax Number: 
412-331-1228
    Provider Enumeration Date: 
08/18/2014